Standards of care in relation to diabetes status in patients with st-elevation myocardial infarction in 2023 - the european unified registries on heart care evaluation and randomized trials

Abstract Background The European Unified Registries On Heart care Evaluation And Randomized Trials (EuroHeart) is a collaboration between national registries of quality of care in Europe. The mission of the collaboration is to monitor and improve the quality of cardiovascular care in Europe. Diabetes is a major risk factor for ST elevation myocardial infarction (STEMI) and variation of care and outcomes exist for diabetic patients admitted with STEMI. We sought to expose any differences in quality of care in contemporary cohorts across Europe. Purpose The purpose of this subproject was to describe the influence of diabetes on baseline characteristics and standards of care in patients with STEMI in EuroHeart countries participating in the registration in 2023. Methods Continuous registration of all admitted patients with STEMI was performed in participating hospitals in from Estonia, France, Hungary, Portugal, Romania, Singapore, and Sweden. The recorded data were predefined, standardized and harmonized between the countries in accordance with the EuroHeart data standards for ACS. The variables included baseline characteristics and processes of care including treatments in hospital and at discharge. The collected individual patient-level data were aggregated after statistical analysis. in subgroups stratified in 9 different age groups, sex and diabetes. The aggregated subsets were presented as proportions and visually compared (figures 1 and 2). Results Between 1st January and 31st December 2023, 26,021 STEMI admissions were recorded of which roughly a quarter were diabetic (23%), a third were female (30%) and the mean age was 66. There was an increasing proportion of diabetes by age and a variability in proportion of diabetes between the countries. Higher proportion of patients with diabetes had other risk factors such as hypertension, previous MI and heart failure. Chronic kidney dysfunction was more common with diabetes (figure 1). A high proportion of patients with STEMI received primary PCI (80-95%) with no differences by diabetes status. There were only minor differences in the prescription of platelet inhibitors, lipid-lowering treatments, beta-blockade or ACE/A2 inhibitors in patients with or without diabetes within the different countries. There were very large differences between the countries in prescription of sGLT2 inhibitors from 22% to 65 % and also a higher prescription in men than women. There was also a large variability between the countries in prescription of GLP-1 receptor agonists varying from 0% - 14% (figure 2). Conclusion The EuroHeart ACS/PCI registry provides a contemporary mapping of the standards of care for subsets of patients admitted with STEMI in Europe. These data showed substantial areas of improvement for secondary prevention of STEMI patients with not least concerning the prescription of the new generation antidiabetic and heart failure treatments at discharge.